OB exam 1 Questions with Verified
Answers
A nurse assessing the laboratory results of a pregnant client in her second trimester
notes that she has a hemoglobin level of 11 gm/dL. What will the nurse interpret this
finding to most likely indicate? - ANSWERShemodilution of pregnancy
During pregnancy, the red blood cell count increases along with an increase in plasma
volume. However, there is a greater increase in the plasma volume as a result of
hormonal factors and sodium and water retention. Thus, the plasma increase exceeds
the increase in RBCs, resulting in hemodilution of pregnancy, which is also called
physiologic anemia of pregnancy. Changes in maternal iron levels would be more
indicative of an iron-deficiency anemia. Although anemia may be present with a multiple
gestation, an ultrasound would be a more reliable method of identifying it. Weight gain
does not correlate with hemoglobin levels.
In preparing for a prenatal class to discuss the hormonal changes during pregnancy,
which information would the nurse most likely include? - ANSWERSOver-the-counter
antacids can be used to treat acid reflux with the health care provider's knowledge.
Elevated progesterone levels cause smooth muscle relaxation, which can result in
relaxation of the cardiac sphincter and reflux of the stomach contents into the lower
esophagus. OTC antacids will usually relieve the symptoms but should be discussed
with the health care provider first. The hormonal changes are necessary for the
pregnancy to continue, and the woman will return to her usual nonpregnant hormonal
levels after the baby is born. Taking hormonal replacement therapy is not
recommended. Using herbs should be done only with the knowledge of the health care
practitioner due to the side effects and contraindications of some herbs during
pregnancy. Some herbs will cause a spontaneous abortion.
A pregnant client in her third trimester, lying supine on the examination table, suddently
grows very short of breath and dizzy. Concerned, she asks the nurse what is
happening. Which response should the nurse prioritize? - ANSWERSBlood is trapped in
the vena cava in a supine position.
Supine hypotension syndrome, or an interference with blood return to the heart, occurs
when the weight of the fetus rests on the vena cava. Cerebral arteries should not be
affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in
any orientation. The sympathetic nervous system will not be affected by the supine
position.
A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She
expresses feeling proud and excited about her pregnancy while at the same time feeling
,fearful and anxious of its implications. Which action should the nurse do next? -
ANSWERSInform the client this is a normal response to pregnancy that many women
experience.
The maternal emotional response experienced by the client is ambivalence.
Ambivalence, or having conflicting feelings at the same time, is universal and is
considered normal when preparing for a lifestyle change and new role. Pregnant women
commonly experience ambivalence during the first trimester.
A mother comes in with her 17-year-old daughter to find out why she has not had a
menstrual cycle for a few months. Examination confirms the daughter is pregnant with a
fundal height of approximately 24 cm. The nurse interprets this finding as indicating that
the daughter is approximately how many weeks pregnant? - ANSWERS24
By 20 weeks' gestation, the fundus of the uterus is at the level of the umbilicus and
measures 20 cm. A monthly measurement of the height of the top of the uterus in
centimeters, which corresponds to the number of gestational weeks, is commonly used
to date the pregnancy.
Which information provided by a client would be considered a presumptive sign of
pregnancy? - ANSWERSBreast tenderness
Presumptive signs of pregnancy are things reported by the woman to the health care
provider and occur early in pregnancy. Breast tenderness is a common sign reported by
women in early pregnancy but is not a definitive sign. Reports of increased hunger and
weight gain could be caused by any disorder or could be normal responses to eating
cycles. Ballottement occurs late in the pregnancy and is a probable sign.
A 24-week pregnant client calls the clinic crying after a prenatal visit, where she had a
pelvic exam. She states that she noticed blood on the tissue when she wiped after
voiding. What initial statement by the nurse would explain this finding? - ANSWERSthe
cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.
Slight bleeding after a pelvic exam in a pregnant woman is common due to the
vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening
and not substantiated by the data. Bleeding is not a normal finding during pregnancy
and losing the mucous plug occurs at the end of pregnancy, just prior to labor.
During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to
avoid what condition? - ANSWERSSupine hypotension syndrome
The left side-lying position prevents the heavy uterus from resting on and compressing
her vena cava, a condition known as supine hypotensive syndrome. Compression of the
vena cava can cause maternal hypotension and poor gas exchange between the
placenta and fetus. Preeclampsia is a condition characterized by elevated blood
pressure and proteinuria. Once diagnosed, the treatment includes resting in a left-lateral
, position, but a side-lying position does not prevent preeclampsia. Urinary frequency in
the third trimester is due to the enlarged uterus pressing on the bladder and is not
influenced by position. Remaining in an upright position for 1 to 2 hours after meals
helps to decrease heartburn.
A client in her second trimester of pregnancy reports discomfort during sexual activity.
Which instruction should a nurse provide? - ANSWERSModify sexual positions to
increase comfort.
The nurse should instruct the client to change sexual positions to increase comfort as
the pregnancy progresses. Although the nurse should also encourage her to engage in
alternative, noncoital modes of sexual expression, such as cuddling, caressing, and
holding, the client need not restrict herself to such alternatives. It is not advisable to
perform frequent douching, because this is believed to irritate the vaginal mucosa and
predispose the client to infection. Using lubricants or performing stress-relieving and
relaxation exercises will not alleviate discomfort during sexual activity.
A new mother voices concerns about breast-feeding her infant. The nurse would explain
to the mother the two hormones that control lactation and letdown are: -
ANSWERSprolactin and oxytocin.
Prolactin and oxytocin are both important hormones in regulation of breast-feeding.
Prolactin helps in producing the breast milk and oxytocin stimulates letdown during
breast-feeding. The other hormones do not play a role in breast-feeding or milk
production.
Which assessment finding in the pregnant woman at 12 weeks' gestation should the
nurse find most concerning? The inability to: - ANSWERSdetect fetal heart sounds with
a Doppler.
Fetal heart sounds are audible with a Doppler at 10 to 12 weeks of gestation but cannot
be heard through a stethoscope until 18 to 20 weeks of gestation. Fetal movements can
be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around
20 weeks' gestation. The fetal outline is also palpable around 20 weeks of gestation.
A nurse who has been caring for a pregnant client understands that the client has pica
and has been regularly consuming soil. For which condition should the nurse monitor
the client? - ANSWERSiron-deficiency anemia
Pica is characterized by a craving for substances that have no nutritional value.
Consumption of these substances can be dangerous to the client and her developing
fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation
of the client's compulsion to consume soil. Consumption of ice due to pica is likely to
lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the
client has been consuming laundry starch as a result of pica. The nurse should monitor
for constipation in the client if she has been consuming clay.
Answers
A nurse assessing the laboratory results of a pregnant client in her second trimester
notes that she has a hemoglobin level of 11 gm/dL. What will the nurse interpret this
finding to most likely indicate? - ANSWERShemodilution of pregnancy
During pregnancy, the red blood cell count increases along with an increase in plasma
volume. However, there is a greater increase in the plasma volume as a result of
hormonal factors and sodium and water retention. Thus, the plasma increase exceeds
the increase in RBCs, resulting in hemodilution of pregnancy, which is also called
physiologic anemia of pregnancy. Changes in maternal iron levels would be more
indicative of an iron-deficiency anemia. Although anemia may be present with a multiple
gestation, an ultrasound would be a more reliable method of identifying it. Weight gain
does not correlate with hemoglobin levels.
In preparing for a prenatal class to discuss the hormonal changes during pregnancy,
which information would the nurse most likely include? - ANSWERSOver-the-counter
antacids can be used to treat acid reflux with the health care provider's knowledge.
Elevated progesterone levels cause smooth muscle relaxation, which can result in
relaxation of the cardiac sphincter and reflux of the stomach contents into the lower
esophagus. OTC antacids will usually relieve the symptoms but should be discussed
with the health care provider first. The hormonal changes are necessary for the
pregnancy to continue, and the woman will return to her usual nonpregnant hormonal
levels after the baby is born. Taking hormonal replacement therapy is not
recommended. Using herbs should be done only with the knowledge of the health care
practitioner due to the side effects and contraindications of some herbs during
pregnancy. Some herbs will cause a spontaneous abortion.
A pregnant client in her third trimester, lying supine on the examination table, suddently
grows very short of breath and dizzy. Concerned, she asks the nurse what is
happening. Which response should the nurse prioritize? - ANSWERSBlood is trapped in
the vena cava in a supine position.
Supine hypotension syndrome, or an interference with blood return to the heart, occurs
when the weight of the fetus rests on the vena cava. Cerebral arteries should not be
affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in
any orientation. The sympathetic nervous system will not be affected by the supine
position.
A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She
expresses feeling proud and excited about her pregnancy while at the same time feeling
,fearful and anxious of its implications. Which action should the nurse do next? -
ANSWERSInform the client this is a normal response to pregnancy that many women
experience.
The maternal emotional response experienced by the client is ambivalence.
Ambivalence, or having conflicting feelings at the same time, is universal and is
considered normal when preparing for a lifestyle change and new role. Pregnant women
commonly experience ambivalence during the first trimester.
A mother comes in with her 17-year-old daughter to find out why she has not had a
menstrual cycle for a few months. Examination confirms the daughter is pregnant with a
fundal height of approximately 24 cm. The nurse interprets this finding as indicating that
the daughter is approximately how many weeks pregnant? - ANSWERS24
By 20 weeks' gestation, the fundus of the uterus is at the level of the umbilicus and
measures 20 cm. A monthly measurement of the height of the top of the uterus in
centimeters, which corresponds to the number of gestational weeks, is commonly used
to date the pregnancy.
Which information provided by a client would be considered a presumptive sign of
pregnancy? - ANSWERSBreast tenderness
Presumptive signs of pregnancy are things reported by the woman to the health care
provider and occur early in pregnancy. Breast tenderness is a common sign reported by
women in early pregnancy but is not a definitive sign. Reports of increased hunger and
weight gain could be caused by any disorder or could be normal responses to eating
cycles. Ballottement occurs late in the pregnancy and is a probable sign.
A 24-week pregnant client calls the clinic crying after a prenatal visit, where she had a
pelvic exam. She states that she noticed blood on the tissue when she wiped after
voiding. What initial statement by the nurse would explain this finding? - ANSWERSthe
cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual.
Slight bleeding after a pelvic exam in a pregnant woman is common due to the
vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening
and not substantiated by the data. Bleeding is not a normal finding during pregnancy
and losing the mucous plug occurs at the end of pregnancy, just prior to labor.
During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to
avoid what condition? - ANSWERSSupine hypotension syndrome
The left side-lying position prevents the heavy uterus from resting on and compressing
her vena cava, a condition known as supine hypotensive syndrome. Compression of the
vena cava can cause maternal hypotension and poor gas exchange between the
placenta and fetus. Preeclampsia is a condition characterized by elevated blood
pressure and proteinuria. Once diagnosed, the treatment includes resting in a left-lateral
, position, but a side-lying position does not prevent preeclampsia. Urinary frequency in
the third trimester is due to the enlarged uterus pressing on the bladder and is not
influenced by position. Remaining in an upright position for 1 to 2 hours after meals
helps to decrease heartburn.
A client in her second trimester of pregnancy reports discomfort during sexual activity.
Which instruction should a nurse provide? - ANSWERSModify sexual positions to
increase comfort.
The nurse should instruct the client to change sexual positions to increase comfort as
the pregnancy progresses. Although the nurse should also encourage her to engage in
alternative, noncoital modes of sexual expression, such as cuddling, caressing, and
holding, the client need not restrict herself to such alternatives. It is not advisable to
perform frequent douching, because this is believed to irritate the vaginal mucosa and
predispose the client to infection. Using lubricants or performing stress-relieving and
relaxation exercises will not alleviate discomfort during sexual activity.
A new mother voices concerns about breast-feeding her infant. The nurse would explain
to the mother the two hormones that control lactation and letdown are: -
ANSWERSprolactin and oxytocin.
Prolactin and oxytocin are both important hormones in regulation of breast-feeding.
Prolactin helps in producing the breast milk and oxytocin stimulates letdown during
breast-feeding. The other hormones do not play a role in breast-feeding or milk
production.
Which assessment finding in the pregnant woman at 12 weeks' gestation should the
nurse find most concerning? The inability to: - ANSWERSdetect fetal heart sounds with
a Doppler.
Fetal heart sounds are audible with a Doppler at 10 to 12 weeks of gestation but cannot
be heard through a stethoscope until 18 to 20 weeks of gestation. Fetal movements can
be felt by a woman as early as 16 weeks of pregnancy and felt by the examiner around
20 weeks' gestation. The fetal outline is also palpable around 20 weeks of gestation.
A nurse who has been caring for a pregnant client understands that the client has pica
and has been regularly consuming soil. For which condition should the nurse monitor
the client? - ANSWERSiron-deficiency anemia
Pica is characterized by a craving for substances that have no nutritional value.
Consumption of these substances can be dangerous to the client and her developing
fetus. The nurse should monitor the client for iron-deficiency anemia as a manifestation
of the client's compulsion to consume soil. Consumption of ice due to pica is likely to
lead to tooth fractures. The nurse should monitor for inefficient protein metabolism if the
client has been consuming laundry starch as a result of pica. The nurse should monitor
for constipation in the client if she has been consuming clay.
